One wonders -- if by "one" I mean me, and I do -- what the failure of Trump's #1 legislative agenda will mean for his nascent administration. Of course he will blame the Democrats and the media and Republicans and healthcare providers, he'll never admit that it was a bad idea from the starting gate.

But the larger implications are looming. Trump has lost his mandate. He has lost Congress. He no longer plays for the same team (the other team no longer plays for the same team). Congressional Republicans may be so divided at this point, so fractured, that they'll obstruct each other the way they obstructed Obama. It's a lot easier to be the Party of No than it is to actually pass any legislation.

Yesterday, a republican senator was interviewed on why the republicans are so divided over health care reform. After all, Chuck Todd asked, hadn't they voted FIFTY TIMES to repeal Obamacare while Obama was in office? "Yes," he replied, "but it's a lot easier to obtain consensus knowing that the president will never sign it." Unfuckingbelievable.

I could see Congress turning against this president in a big way, moving forward with the Russian interference probe and initiating impeachment when it is proven that Trump promised to lift the sanctions if Russia helped him get elected.

So, from where I sit (a hotel room in Tokyo right now…), I don’t see how President Pence is worse than Annoying Orange.

I know that Pence holds some pretty stupid views and would push an extreme fundamentalist agenda. But here’s the thing: Isn’t that already happening/going to happen under Trump? What would Pence do that’s not already underway now? What radical conservative ideas would be given room to breathe that aren’t already? What cabinet appointee could he make that’s worse than what we have now? What SCOTUS nominee could he make that’s worse than the current list?

Disaffected white working class would lose their champion and defender, you say? Please.

And at least Pence is nominally sane and has some notion of… oh, I don’t know… public service, democracy, decency, younameit. Trump is so bad he makes Mike Pence look good.

Congress is doing an OK job of being an independent branch right now. Would the GOP caucus all get behind some looney toons bill sent up by a Pence White House? Seems unlikely.

And Bannan and the rest of the Breitbart crew would be shown the door. The whole effort to break the government would probably taper off.

And Pence probably couldn’t win in 2020. I’m having trouble seeing the downside.

Pence would make us all want to drink, but I kinda think I’d rather want to drink than worry so much about a moron breaking the global economy or starting a war.

And it would be a lot of fun to watch Trump go through impeachment and have his lying, narcissistic, kleptocratic ass shown the door. So I vote for that.

for all the bashing Republicans have given the Affordable Care Act as government overreach and “socialized medicine,” Obama’s signature health care law was built upon a Republican, market-based foundation.

Its core principles were dreamed up in a conservative think tank in the 1990s as a way to counter the far more sweeping health-care plan pushed by President Bill Clinton. A version of it was implemented a decade later in Massachusetts under Republican Gov. Mitt Romney.

This, in fact, was the reason so many liberal Democrats were infuriated with Obama in 2009 for proposing a GOP plan to start with, rather than a single-payer scheme like they preferred. Obama, having started with a plan he believed Republicans should have been eager to support, grew frustrated when GOP leaders instead decided to oppose it unanimously and characterize it as a typical liberal entitlement.

Yet Obama’s negotiating strategy, or lack of one, notwithstanding, the ACA in the end was designed to deliver health care using the existing model of private insurance using government subsidies for premiums. The much-derided “individual mandate” to purchase health insurance would not have been necessary had Democrats gone with a “Medicare for all” proposal, but was crucial under the ACA to hold down premiums by spreading the costs of serious illnesses across a wider base.

Republicans who have claimed for seven years that they could replace the law with something that would eliminate the mandate yet cost less and provide better health care ― Trump went so far as to promise coverage to everyone ― are quickly getting a lesson in reality.

Chief among them: Trump himself, who explained something new he had learned ― that making one change in one part of the law has consequences in other parts of the law. “Nobody knew that health care could be so complicated,” Trump said last month.

With the collapse of the House health-care bill, the cause of repealing Obamacare, a right-wing obsession for seven years and a day, has died. The flame will never be fully extinguished in the hearts of the true believers — after all, in right-wing think tanks and other places far removed from electoral politics, anti-government zealots still dream of phasing out Social Security or Medicare. But the political project dedicated to restoring the pre-Obamacare status quo, in which people too sick or poor to afford their own insurance without the subsidies and regulations of the Affordable Care Act could be safely ignored, is gone forever. And it is dead for the best possible reason, the reason that undergirds all social progress: because a good idea defeated a bad one.

Conservatives have already collapsed into mutual recriminations for their failure. Reporters have blamed Trump’s deal-making skills. Trump’s loyalists are loudly blaming Paul Ryan. “I think Paul Ryan did a major disservice to President Trump, I think the president was extremely courageous in taking on health care and trusted others to come through with a program he could sign off on,” Chris Ruddy, CEO of the right-wing site Newsmax and a longtime friend of Trump’s, tells Bloomberg. “The president had confidence Paul Ryan would come up with a good plan and to me, it is disappointing.” David Brooks blames both Trump and Congress. “The core Republican problem is this,” he writes. “The Republicans can’t run policy-making from the White House because they have a marketing guy in charge of the factory. But they can’t run policy from Capitol Hill because it’s visionless and internally divided.”

Paul Ryan’s ascent to House Speaker is illustrative. His fans on both sides of the aisle have long described him as a savvy policymaker. “He is, arguably, the most skilled policy entrepreneur of his generation,” Vox’s Ezra Klein wrote last week. “He is known for winning support from political actors and policy validators who normally reject his brand of conservatism.” But there is a difference between a “policy entrepreneur” and a “legislator.” The former deals in theories and spreadsheets and white papers and Powerpoint presentations; the latter deals in real-life political power. And while Ryan can be credited (or blamed) for popularizing a certain strain of conservative fiscal policy within his party, his record of translating those ideas into law is quite modest.

In that way, Ryan is prototypical of today’s Republican congressman. To the extent that the mythical backroom wheeler-dealer types every truly existed, they have been largely purged by the purifying flames of ideological orthodoxy. Those who remain adhere to an incentive structure that would be all but unrecognizable to a lawmaker who left town a decade ago.

The democratization of media has made it so that D.C. Republicans are just as likely to pander to Sean Hannity as they are to their local newspaper editorial boards. And the deregulation of political money has enabled cash-flush outside groups with narrowly tailored agendas to strip party committees and old-guard gatekeepers of their power and relevance. The result is a caucus full of conservatives with excellent ratings from the Heritage Foundation, and no idea how to whip a vote.

Consensus now is that Trump and his minions will attempt to kneecap Obamacare through the upcoming budget reconciliation process. Their HOPE -- odd though it is -- is that a lack of funding (allowances, rebates, reimbursements, keeping the exchanges open) will cause Obamacare to actually collapse as they've been saying it will -- despite the facts to the contrary from the CBO -- and when it collapses, the Democrats will receive the blame rather than the Republicans.

Seems like a pretty dicey gamble. Throwing American healthcare into a crisis so you can blame somebody other than yourself when millions of people face emergencies and untenable choices. It's despicable politics is what it is.

the ACA in the end was designed to deliver health care using the existing model of private insurance using government subsidies for premiums. The much-derided “individual mandate” to purchase health insurance would not have been necessary had Democrats gone with a “Medicare for all” proposal, but was crucial under the ACA to hold down premiums by spreading the costs of serious illnesses across a wider base.

So, let me ask this. If Medicare was expanded to "all," would companies still be required to provide health insurance to their employees? In countries with socialized medicine, is there a "private / public" healthcare divide where only retirees, the unemployed, mothers and children are covered by the government?

Or, if "free" (paid for by taxes) insurance was a national right from cradle to the grave, would companies save tens of thousands of dollars for every employee and thus suddenly become much more competitive internationally?

Everybody is covered with no point of service charge (no invoices, no copays, no deductibles) under the National Health Service. Companies don't have to worry about health care for their employees, since those employees are already covered by the NHS. (A comment sometimes made, but not nearly often enough, about the American dogs-dinner of a system is that it is a major millstone around the necks of growing companies. The expense and paperwork associated with health insurance for new employees is a serious drag on growing a start-up company. Universal health care would be a boost for businesses, especially small businesses and entrepreneurs, in the US.)

However, in the UK there is a private health insurance market which you can use - you can buy private health insurance if you want to and can afford to (it's expensive). Since almost everybody uses the NHS, resources are often stretched. For elective and even needed but not urgent treatment, you may find yourself on a waiting list. If you have private insurance, typically you don't have to wait, and you may well have access to some toney doctors and facilities that won't accept NHS patients. That is attractive, and that means that even though it isn't really necessary, private health insurance is quite a nice perk for high-paying jobs to offer.

I could see a similar arrangement working for the US under "Medicare for everybody". Since Medicare doesn't pay for everything, there is a market for supplemental insurance. You can envision employers offering subsidized supplemental insurance as part of a benefits package, even though they wouldn't have to, since Medicare would be doing the heavy lifting.

Doctors in this country have gotten so fucking greedy that insurance is no longer a guarantee of service. In the city we lived in for thirty years, and to which we may move back, a great many - maybe all - of the doctors are charging a yearly fee, beginning at $1,500, just to be a patient. Many of them are now charging an "administrative fee" of $100 or more for each office visit. All of these charges are in addition to the copay for your insurance. And few insurance plans are accepted by most of the doctors. Even the physician I see (in a smaller town) does not accept insurance from United Healthcare, which is the largest health insurer in the country. A great many doctors will not accept Medicare patients, or even older patients.

As much as I despise the health insurance industry, they are not the only problem. Good old American greed denies health care to many people.

Fuck the Republicans. Fuck the insurance industry. Fuck their profits.

The USA is the only developed country in which people go bankrupt for health care. The number of people in the UK who go bankrupt for medical expenses is exactly zero. And the same goes for most other wealthy countries. In this country, more than fifty percent of all bankruptcy filings are for medical expenses - for people who have insurance.

My great-nephew was just diagnosed with non-hodgkin's lymphoma and started chemo therapy yesterday. Surprise! His health insurance won't pay for it. Why? Because they don't want to and the law won't make them.

Why can't this asshole country join the twentieth century (it would be asking too much for it to join the twenty-first century) and provide single-payer health insurance? The method we have now is by far the most expensive in the world and provides significantly worse outcomes.

Why can't this asshole country join the twentieth century and provide single-payer health insurance? The method we have now isby far the most expensive in the world and provides significantly worse outcomes.

NoCoPilot wrote:

The problem is it eliminates an industry, a large very well-funded industry that does a lot of lobbying. Republicans don't like to kill jobs.